DURBAN, South Africa — While the world has made progress reducing the number of people who die from AIDS every year by expanding access to life-saving drug treatments, many countries are increasingly failing to prevent the spread of HIV.
That’s the disturbing gist of a new report released here at the 21st International AIDS Conference by my organization, the University of Washington’s Institute for Health Metrics and Evaluation (IHME).
South Africans woke up this morning to the headline “HIV mugs 500,000” on the front page of one of this nation’s most influential newspapers, The Times. They learned that with 529,000 new HIV infections in 2015, their nation had more new cases last year than any other country.
But it’s not just bad news for South Africa.
The new study, published in The Lancet HIV and entitled HIV 1980 – 2015: The Global Burden of Disease (GBD) Study 2015, found that 74 countries have experienced increases in age-standardized rates of new HIV infections between 2005 and 2015. Other than South Africa, these countries include Egypt, Pakistan, Kenya, the Philippines, Cambodia, Mexico, and Russia.
“The findings reveal challenges that the global health community faces in the effort to end AIDS by 2030, among other global goals,” says Haidong Wang, the lead author on the study and an associate professor at the Seattle-based IHME.
The Institute coordinates the massive and regularly updated Global Burden of Disease study, which is involves more than 1,700 scientific collaborators in 124 countries. It is the largest and most comprehensive such global health effort measuring epidemiological trends and data worldwide.
In addition to increasing or stagnant rates of infections, Wang noted that numbers of new infections increased in 102 countries between 2005 and 2015, which he said represented “a significant finding that underscores the need for a response from the global health community.”
Haidong Wang answers questions about his study. Credit: Dean Owen
“There must be more concerted efforts in prevention of HIV transmission including behavioral prevention programs promoting safe practices, detection programs to catch HIV earlier, programs that improve access and affordability of anti-HIV medication that keeps HIV-negative people from becoming infected, and treatment programs for those already infected.”
Professor Peter Piot, who is the director of the London School of Hygiene and Tropical Medicine and was the founding executive director of UNAIDS, also remarked on the paper’s findings at a press briefing at the International AIDS Conference
“This study shows that the AIDS epidemic is not over by any means and that HIV/AIDS remains one of the biggest public health threats of our time,” Piot said. “The continuing high rate of over 2 million new HIV infections represents a collective failure which must be addressed through intensified prevention efforts and continued investment in HIV vaccine research.”
Wang was asked why the GBD statistics differ from those released July 12 by UNAIDS
“First and foremost, the GBD 2015 estimates provide a more comprehensive and internally consistent picture of the HIV/AIDS landscape including estimates for HIV-TB and disability associated with HIV/AIDS,” he said.
In addition, he cited “innovative and improved methods and updated data,” acquired through vital registration systems, which Wang called “one of the most reliable sources on the course of the HIV epidemic. Data from these systems are not systematically used by UNAIDS.”
In contrast to new infections, the number of people living with HIV has significantly increased globally, largely due to the expansion of antiretroviral therapy (ART). IHME estimates there were about 39 million people globally living with HIV in 2015, as compared to 28 million in 2000.
In 2015, 41 percent of the people living with HIV were using ART, as compared to less than 2 percent in 2000.
Access to treatment is not just about preventing disease and death. Many studies have shown that people with HIV who receive proper and early access to treatment can reduce viral loads to the point where those with the infection do not pass it on to their sex partners. Many activists here at the conference have re-emphasized that point with the simple phrase “Treatment is Prevention.”
Interestingly, the paper finds that use of ART is different between men and women. On average, global ART use is 10 percent higher among women living with HIV, and in some sub-Saharan nations in 2015, it is 50 percent higher. However, in some Eastern European and South Asian nations, the percentage of men using ART is as much as 50 percent higher than women.
In regard to mortality, women tend to die at younger ages from HIV than men, likely due to age-disparate relationships in which men have sex with younger women. In total, approximately 1.2 million people died from HIV in 2015, down from a peak of 1.8 million in 2005.
The results of the GBD paper underscore the need for more effective efforts to prevent new infections, as well as additional funding for these efforts. Development assistance for health (DAH) dedicated to HIV/AIDS grew fastest between 2000 and 2009, yet such funding has stagnated since 2010.
According to Financing Global Health 2015, a report published in April by IHME (http://www.healthdata.org/health-financing), annual funding globally for HIV/AIDS peaked at US$11.2 billion in 2013, but dropped to US$10.8 billion in 2015.
And what about those residents of South Africa concerned about these new findings and their nation being called out for having the most new infections in the world?
Dr. Charles Wiysonge, a GBD collaborator and professor at the University of Stellenbosch in Cape Town, noted in The Times article that “there is no reason we should be seeing half a million new infections.”
“That tells us that we are not doing as well as we should be doing,” he said.
